Your Digest for Saturday, Apr 06, 2024 04:59 PM


TypesOfCongenitalAdrenalHyperplasia.png

Why 11-beta-hydroxylase deficiency causes hypertension even though it results in reduced aldosterone synthesis:

" because of overproduction of cortisol precursors that are, or are metabolized to, mineralocorticoid agonists." Source


[!INFO] Mnemonics
REDMAN or SCALP-ID
REDMAN : Eczema / psoriasis, Drugs, Malignancy (mycosis fungoides, CTCL, Autoimmune, No identifiable cause)
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SCALP-ID
ErythrodermaMnemonic.png


Apparent mineralocorticoid excess syndrome

[!TIP] Mnemonic: Similar to Conn's syndrome but with low renin and aldosterone.

Caused by deficiency of 11-beta-dehydrogenase.
Features:


Streptococci

Comparison of some medically important streptococci

[!TIP] Common terminology

Feature Strep pyogenes Strep agalactiae Strep Viridans Strep pneumonia
AKA Viridans Group Strep Pneumococcus
Clinical
manifestation
Pharyngitis, Scarlet
fever, Soft tissue infection
Neonatal infection,
adult pelvic infection
Endocarditis Pneumonia
Complications Rheumamtic fever, PSGN, PANDAS
Haemolytic typee Beta Beta Alpha Alpha
Lancefiled Group A B None None
Morphology Chains Chains Diplococci / chains

[!INFO] Membranoproliferative and Mesangioproliferative are described under "acute nephritic syndromes" in Harrison's
This probably means they present more often as nephritic syndromes but also can have some proteinuria.

  1. Autoimmune
  2. Chronic infections

There is (From Harrison's)

  1. Mesangial expansion +/- mesangial hypercellularity.
  2. Single contoured capillary walls
  3. Mesangial immune deposits.

C3 glomerulopathies

Dense deposit disease C3 glomerulonephritis
Defined by presense of ribbon like dense deposits in the GBM. Similar but no ribbons
Children and young adults mean age 30
Proteinuria + haematuria (nephrotic range proteinuria in 1/3) haematuria and 1/3 have proteinuria
Poor prognosis : half develop CKD. ??
Normal complement levels Low complement levels
Visceral abscess ⭐Cryoglobulinaemia
[[Miscellaneous respiratory medicine#Polyarteritis nodosa (PAN)|Polyarteritis nodosa]] SLE
[[2022 November SBR#Goodpasture's syndrome|Goodpasture's Syndrome]] ⭐Bacterial endocarditis
Henoch-Schonlein purpura ⭐Shunt nephritis (VP shunts)
(i.e infected shunt)
==Sometimes MPGN==
==and PSGN==

The surprising ones are highlighted; basically, myopathies tend to cause proximal symmetrical weakness; distal weakness is more likely due to nerve issues.

Paraneoplastic Dermatoses

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Source

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These are the Dermatoses which almost always occur with a malignancy.
| Lesion | Association | Mnemonic |
| ------------------------------------ | ----------------------------------------------------------- | ----------------------------------------------------------------------------- |
| Tripe palm (aka pachydermatoglyphia) | Lung cancer, gastric cancer | Occurs together with ANM |
| Acanthosis nigricans Maligna (ANM) | Gastric Adenocarcinoma | AN is connected to things relating to fat / stomach / tummy |
| Erythema gyratum repens | pulmonary, oesophageal, breast | Forests (wood grain appearance of rash) are the lungs of the world |
| Acquired hypertrichosis lanuginosa | colorectal, pulmonary and breast | Hairy butt |
| Bazex syndrome | Aerodigestive | |
| Acquired ichthyosis | Lymphoma | Lymfishma |
| Dermatomyositis | Ovarian Ca, Lung CA | Common in women -> ovaries.
Also, lungs
Associated with "paired organs" |
| Migratory thrombophlebitis | Pancreatic CA | Let's assume scorpion stings also case thrombosis |
| Necrolytic migratory erythema | Glucagonoma | Always carry glucose while migrating |
| Pyoderma gangrenosum | myeloproliferative disorders | pyo/myo |
| Sweet syndrome | Haematologic malignancies | Sweets raise blood sugar |
| Tylosis | Oesophageal cancer | Tie a tie around the oesophagus |
| Leser-Trelat | Gastric and colorectal | |
| Paraneoplastic pemphigus | NHL, CLL, Castleman Disease, Thymoma | |
| Pytiriasis rotunda | Hepatocellular carcinoma, gastric and oesophageal carcinoma | |
| Palmoplantar keratoderma | Oeseophageal SQC | |
| Pyoderma gangrenosum | | |
| Sweet syndrome | AML, MDS, | |
| pyoderma gangrenosum | MDS, myeloma, leukemia | |
Bazex syndrome
BazexSyndrome.png

Pytiriasis rotunda
![pytiriasis rotunda.png](pytiriasis rotunda.png)

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Necrolytic Migratory Erythema
necrolyticMigratoryErythema.png

Dermatologic condition Associated
Hyperkeratotic and proliferative dermatoses -
[[2022 General Medicine Paper-May#Acanthosis nigricans]]
Florid cutaneous papillomatosis (rapid eruption of warts) Stomach cancer
Sign of Leser-Trelat (rapid appearance of seborrheic keratoses) Gastrointestinal adenocarcinoma AND many others
Tripe palm (velvety thickening of palmar skin) Gastric or lung cancer
Icthyosis Hodgkin's lymphoma
Palmoplantar keratoderma Associated with SQC of oesophagus = Howel-Evans Xn
Bazex Xn: psoriatic like plaques on fingers and toes (acrokeratosis paraneoplastica SQC of aerodigestive tract
Inflammatory dermatoses - erythematous or violaceous skin eruptions
Sweet syndnrome (dermal,non vasculitic neutrophil infiltration with fever + neutrophilia) Acute myeloid leukemia, lymphoma
Dermatomyositis Ovarian, breast, cervical,uterine + others
Erythroderma (usually caused by psoriasis or atopic dermatitis) Cutaneous T cell lymphoma
Erythroderma gyratum repens Bronchogenic carcinoma
Pancreatic panniculitis Pancreatic cancer
paraneoplastic pemphigus (PAMS) Non-hodgkin lymphoma, CLL
Mucous Membrane pemphigoid Unspecified but associated with malignancy
-
Hyperpigmentation
Hyperpigmentation in ectopic ACTH poduction (ectopic cushing's syndrome) Small cell lung CA
( POMC produced by the tumour is a precursor of ACTH and MSH )
Generalized dermal melanosis Extensive metastatic melanoma
Skin manifestations of amyloidosis [[2022-November#Amyloidosis]] plasma cell dyscrasias such as multiple myeloma, and less frequently, Waldenström macroglobulinemia

Basis is hyperkeratosis and epidermal papillomatosis as seen on histology. Black color is not due to melanin but due to the hyperkaratosis. Source

Endocrine (Cushing's and Acromegaly)
N if for iNjected Insulin and other drugs


aka acute febrile neutrophilic dermatosis.